1999 - A Ion Of The Quality Of Life Of Severely Mentally Ill People In Germany And The Uk

(1999)vol 46 Na i 1 !^ler.rtonal Jouf,al ol SocnLPsrchiat'l

'

] OF SEVERELY A COMPARISONOFTHE QUALITY OJ I \i,'i\ S'AMPLES MENTALLY ILL PEOPLEIN UK & Gi:' S. EVANS, P. HUXLEY & S IF SUMMARY

l:,:t*fii li[1"""ruxuiff#::'"miiur

1iq*i#! iffiq,:{,ifi:F:$i"tr#r";;:rt+:: -"+:*ii"h*'i'"r"ruti1i!itqi :li;T;ffi ',?":"'i":'H:^1":S.$:ili:i::::*:*ri*:f i:t"*1";"lnlL*l*ll i es ::*:";iril{: #".1i:::il':"T"t*::'#tJ*.:#;J: \as oeoress'on *' iii{:ri L";r;m"'t""1;J[1;l

*'g,;"'ul"'"1""-*,.::':"".ji, ,i.'-.i-"..,. :: :"fJ"i'*:,I ;onfirms thal age depressionand oblecrrvectr

:,ii"::::;::r i :ig*i";'i:*i'**:*i!m=:**' -,lt;$.J*rii rn#*i*:l*tff"'r,#!d1ir3r", e : p l a i n e di n b o t h s a m p e L no l o b a w e l l ' b e r n g Ge;an samplesand 38% In the UK sample)

INTRODUCTION rs a k€y objecdv€for qyl","i ll: :l pi::l::','X',""'.'::i rhe rm.ov,ns : ' iii'"?l'"',illl"iil the one . ,""1'"r r,J"r* p"ri.l andclrnicollrearmenlOn 1991)

in thehednr .l Li grneral (Bowling' ","*i i.lri"i"i, r" q'"utv oflife assessment for usein mentalret ' .rnices (e.c the I-ancashre instrumentx i.i ti"-a"*r"pt*i"i . th.r hand there have been

r! :l: lli9l - " oriver i"-rlq "i r-irJp.nr. rQoLPr'

.. r : {itoiloway,1996)ln sPite

H;:'*J";ii; 1,';'"t'11'11;;1^1"1,""'"T:jllTT:::'.H,:::,l :s and significant advances

ro er hascorrrnued "i r.t. ."u.ir"t' *. pohcyagenda :" heahh tal ro'T"L--.ar outcome measue ,mfrovements ar

i.

.^r*r.",

". .. '.,n"o"losv areb€ingmadePnebe&

F|}NIC MBKIN. j G iiej! tot pr. rosiineinc :r ,t .irlts) 68, I rvrru Ol r-,0 SMITH D. r. ' SVng. p A r'rltjr Md CodmJntl WECHSL-ER. n r: hosprtiLiEton

I htduoor f, .n" ;.;,;;;;; ,e.ondrd$o! - r

DENSITY E!!TI]I

hospihliation hsatds oi mlno'iivshtus il'ntrl rr !{'tr!l irbnn d.rsnv lnd psvchrar.rc \ 566 '" 'd u s o n r nP r l ' s r o u ' ' o r r c r (J n o e n o L o l r ' o ' J r b $ ( e 4 ' ' i!l t n ' @ t J t t o o \ o ^ t a | '- o d o n P E P -. t ter t.S' n satati 'lmonosworLh Pengd'n C lotgi) rhe.f;unh notionalsun', oJ 'thnic nnantizs kchnicolt'P't: Lanttjt S\:tt') J rnnrg ileserch -\ rirtrlr_ lcn. i r (tX?) ri ot individurlaDdcomnunnl chdrccnsricsandor:s or "/rn," i,lmal oJSaciolost T3 llt-334

.

I

' Fspon{bicfor h' d'sisn on*ruc 'o' ud 'npkm'nLno- of$r '{ltl , : . " . " i , . " . ) * " ' b . o , n f t p J F r .s * e r r a r e a o , n s .hn. c , . 1 ' ' ro e or lhc d"! analvr sd ma r Epon oiIn' heclrbrd melbrhear 5'

rrl -n

-" veis,ryL.ctur.r, Fac0ltvof Scral rd PoliricalScrenc.s.Unive*iL\ or ctrirhnie€ Dlvd Hrlp.m Ph.t 7-8 J.susLDc Clri .dg. CE5 8BA Uoiv.6ny aouer! l-ri ici Jlnes Nuoo, Scnr: l-d.iur.: D.patm.nr oi Ep'demologvand Public H.alth, wClE 68T l-onao,, Ph.. l-t9 Todingroo ro D srlpcn Codlspondcnc.

,18

QUAL]TY OF LIFE ]N UK & GERMANSA]\,IPLEs

rr h,r\ becomepossjbleb explorelhe narureof tbe qurjil i! iu large -rrl critsin differenrseftjngs,and acrossdiff€renrculrurcs ,. rtr hr bein aOL daradrawinson cornmunitysampie!i: | . r_rsA,UK .o,)ilJnsglj-9f juri.,r 1993)ard ltaly (Wamer& Grrotamo; personatco! r ,l1 on, The selsnra European conlexr datafroma number of somewtr.l,.,.,r:rmururv . t-r. andcermany.Ils main plrrposeis ro explore,usingr . -0" e"ra set's j -sth. extentto wbich the undertyirgstructure of rlr€qualj;y ,|*-.;;i is sinilrr i iiftr.rt cultur€s,andwhat the majordererminants or ovc|at ..11e well_ lhc differentsettings.In addilion,we aim ro esrablishrlc .. .r :,, .fricft .Lrro esto ovemltwell_being. .rrt r' i : .rresrn lne UK rs as"essed QOL usrngr.heLancash.,e ". . D:ofrte r -nd:o:ea:1d^!:i!h a numoerofsamptesfrom e (oher.r ! cen J, ,\rns t:...r'r or rhe LQoLp The LQoLp consrsrs o, qL' .. ,-, u"; anJlbjecdve well-b€in8rarinssin 10lifedomains(t"t-"*., , -, , ,,. i,.ri"g, i.nral healrh. eocrat iclivrty fanx,)retaoonshrps and" .. . aj.i_ tiv€Slooair ,i. e. I heonly(Lbsrantrre differen( e berween rheUK . ,.d tn, no sectionon religionin tle Berlin inrerai€w. Samples Both samDl, conlst of peoplesufferj'g from sev€rementatjtlners, .:. t! s.ilzo_ phrenr!.Th. '-nri ca5esconsisrof 5 grcupsof schr?ophrenia . .;11 sun 1 from Berln .t e et at t. There serc lhre€grouls of inpauen . J -1997 : re.r nrst-J$eeksol ,ta) in general .. .ra) hospal. p.uenrs.r. ronlhsard 2 years(n = 76); andpatienrswirh a hospitalia1 r oie rlm I Thcrewere two ourparientgroupsfrom Berlin servjces.r, ...i3 .,,.ii.nts . lad a longsriy in hospiral andneeded somesoc... ?9 from (he Lrr jrsir\ depanmentof Sociat Psychiarrywhich providesa :j.t,irrive r ltem in a cenrraldrsrici of Bellin. patientsreceivedIC , j ir gn(ses rs! ContinJin!rre ras€sin th€ corn.nunity(UKCC)wereralen from lhe of , .jetrat: of serv'ces workels.Inclusioncnreriafor rhesamplespecit.s ,,. :d|r,tlds shouldhavei -n jn treahenl for ar leasrtwo yean,be subjecitof;equcnr..jj .1,,.: itnd rare-i prychoticdiaCnosis. Hospiraldiagnoses (tCD,g)fo. r, ;, .ad:pli of r : ,rl7) showihat t!'o-rhirdshad a diagnosis of schizoplftrt,r nd l; a

R.ESULTS TIe totalnuml- oi cases inctuded is 1665,1279fromtheUK conmuniry car jt. r.rs. rnd r_ :- r.shos\lhedemosraphicdirrerencesberweenrhei"n .,; ;; ]!9tl,l!,: oala on rhe8r i sJnple Tl'en a or

:w: :f llgn:r' |:

n

is not avartable). .' -.or;cconrrasrs relarero age,TableI I andemptoyt]lp.r ., .:re ..r r turtr))ounger:ts-orte2roflneuKccsroupdeJ,d- ..
49

1. r. belten samPl6

30

1

96 92 21.4% 1524 153 t64 41% 441% r40 ro5 40%% 31.5qo

212 16-6% 111 439% 645 395%

.14 aal% 94 73% 4

i 134 881% 94 13% 4 '3%

.3%

53.1% 595

190 49.2q, 196 12

865 52.2% 79r 214

i62 13% 593 55.9% r88 3t,l%

200 57.2% 104

898 55.3% 492

:t0

782

592

o

lo7

107 118%

UKCC

'.0n

S Il,

a3.4% 203 16.6% 680 54.r% 5?8 45.9%

250 65% t26 33.5% 212 55.2% 112 44.8%

ltz

195% 329 205% 892 541% ?50 451%

I iK&GIRMAITSAM?LES

QUALIaYa:

':rblr

Conparien or i

l t .ubieoiv. well-being*or5

r (i

wor[

Geman n =386

]r):

Unenploycd Eepto).d t sc

l!.r

Ljving Snlaro.

l.ll

It i95 iE

. t

5d.ty

rMr] Sdial H.nl$ Mdrd b.alth Glob.l wcll b.ing

I fl I i:' i:1/.

; th€ fac! that the Berlin sample rc !, e ilely schizophreniasufferers.IJr acr| thereforehave bad a shorter metlll rl : are cunendy narried (Cb1 squartd = eve!-manied rate in bolb samplesis .r also have very similar livitg srtuat,of. Table 3 shows the meansubjecti\c domairs, subjectiv€ well-being n].!,r ' the Berlin cases,exceptin t€rms of l:' UK samplehas fewer casesiD €m! i',:i in lhis domain, althoughthe differe r.. . those in work and out of work in L. il is greaterin th€ UK than it is in Ce,, palientsin terms of family, health, 'J. ., are betweentbe finatce ratirgs, qrth il

.l

i73 l?8 112 :08 i/6 178 )13 lt0

452 4.38 4.12 4.90 4.39 4.81 4.91 5.m 4 93 4 70 451 4.48

-441 A!) -4.68 .000 .96 .311 -2.30 .022 -6'l 000 1.40 .162 -.42 .611 -395 .000 -4 20 000 -2.83 .005 -3.65 .000 -2.33 .020

and are i mnanlly fiom acule treatmentset1lDgs ,, (heyarea morereccntlyacutelyiI gtoupand . cueer'. Althoughnore of the Germa,sample tha!tb€ lri. df =2, p<.05), it is interesting :njiar (UKCC /ta%;Bedin 47%) Bolh Sroups r:ing scoresfor bothsamples by domain.Inmost 'r.- ttl(CC casesare srgnrficandy lower rhan :-udrionor thc closelyr€latedsafetydomain.The r and reporrssiightly higher levels of satjsfaction comFrisonsbetween significant. Nevenbel€ss, :..)ups.suggeslsthat th€ impactof not worhng The.e are significant advantagesfor the Bertin differ€nces .-, lejsureratings.Themostsubstantial - ,b€ner off in latren6 feeLngsubnantrallv

thanthe One possible exPlanationis that ih,: I :: 1 patierlsare in moreactivetreannent cde. effect,\e .ocial or appropnak . more rn :fUK group and conseq'rentlyare have sample in the Berlin sufferers yoL:rg., rzolhrenia thc Another possibility is that suft€red have tbe uK rample | ."ny of $tarer ri.l ltves and family mor€ intact social attdiion in these areas over th€ yers Subjective w€ll-being and demogr!phi. There were a nulDberof significanrdLir. ,ies in SWXbetweenmenandwomenin theLrX samples,but o.ly one in tbe Berhr silri: ... iTrble3). andLrrsuas ng 6cantin ..r unemplo)meor Femaleshad higher S'WB score: iN ' Mei had significantly higher ditgs h the UK lhe UK goup, bui not in lhe Berli sr' r:

5l

5. EIANS gr rTlblt 4 qr Th€ rclaboNhiP b.tw€ed subj€cti'! Co

ilnrs rnd gendd

F :isJn: hY g.!d'r

G.n.n

ITKCC(n= 127e)

cs6

(t = 186)

502

3.91 4.75

-3 4E

153 i58

450 4.51

- 14

890

3.61 4.06 4.85

-l i3

91

428

'11

396 352

469

-.,2

61

418

61

532

4.91 4.89 442 431 4.70 4.92 4.12 5.ll 4.94 5 06

15

8?8

26

192

i 25

.2ll

89 9)

l8? L8?

l5

6r9 563 60? 541

3.?8

615 559

468 5.00

r84 r89 r88 t90

-la

$5 187

3.05

551 593 538

4.15 -l i0

606

4.53

22'

549 593 535 626

).1

150 158 186 190

188

4.95 4.92 4.58 4.81 4.38

18? t83

4.4X 4.55

i8? 186

4.0, 4.21

onl) souD in safetv,familvandheclth bur tbc 01 in respecL SwB bgher ripon.d in"r *omen

-296

003

-.61

J03

29

114

-119

075

-l60

rl0

-a2

.414

J fferen"cin t}teBerlL' g'oup rs

'f...:$:IJ-i*?"',T"'.",Tfl S,i,m:u':kllrrll."^i.'l"T*',,1:,?l?:':

:11.:ti:"''r',*,5i*1lg*':,H"**':i:r'H? :

;*'a;*$ffi*l* .*$ tr'Hii'i{tt+*#,"ii""*:*";'

QUALI|Y OF LIFE N I-]K& CERMA,\

1 Mc.n SubFctw

l lell se'nq : cores

;;Gd rfit F $r.

1. D.p.sion lnd it .Itdt on subjetiv. wellbetr

1 2 * p<.0O1, - p<0O5-p<.05

r 4 MGrnSubj.ctiwW. Aein!::ores

@ Flgure 2. D€pBion a

its ef,eclon subjectivee.ll-bcnr. :jerlin s:dpl6

S EVANS'IAL

5]

sir . . ri i of proteclive effecl. In order to test the argumenl rI r . ! re .uhs nay be an !,:. ,, , i the measurementtechnjqueemployed,we rcpeared11. .r . u:.ng standardised . l i , . . r s s e s s m e no t sn a d i f f e r e n ts a m p l eo f ? 0 0 p s y c h o t j r: i { . ' $. found almost r i r ( , u i : l r c s u l l s , t b a l i s t h e r a t i n g s o f r e l i g i o n a n d w o r k w e r,e, ,n. r , nr ,l j o p l e w h o n t e d lepress,onon rhe CPRS l\l ! ti\ 3rjate analysis IlLr ir..f!ie analyses were used to examine the structurc !i l', .srrrmenl and rh€ ddrr:i,irDts of w€llbeing in differert cultures. On€ wai ,ri r.....in! rhe exlent !o \1,,.i1, ir3 lnstrumenisare bebaving in lhe same way is to e\rr r. rl rirderlying factor i., L-lrr to perfonn this analysis we classined ihe Germar i: rr:. xt inpatrentsand oLr' r1r'.3, as this allows for co.nparisonbetweenmore homoli | .. rr. )ps. Only $os€ t!..,1 .-5lvailable to botb data sels were included in the analtsi: , r gi r was excluded tn,,r :r. nodel. Table 5 sholvs that the i|ems tbat emerge,Jr r 'ti ralysis heavily h,,.3c n. the first factor are very similar. The only substanLi.c r -f-rc.r are i! leisure ir.,l l,rr,ce. ln ihe Geman lollg stay sample ]eisur€ is load.,l , r .. i:!:.d factor ralher thr:: rl,:: irIsr. aDd finaDcedoes noi load on the first factor iD erli,.'r,, UI.CC data or the a.t,r: .Jscs in Cermany. A possible explanationis that the ci.u .'r-.i, is if the iong-slay Sr..i r Berlin is differert in that there is a more or l€ss r.rJ, :i.r, ,:i, 1 that provides r.i.rrelevel of mateial benefitsfor palients and $e same tr.._ j. , r lmited range of lcr! r: ]crrvityI ., lLr to investigaretbe relarionshipbetweenoverall well b.i r r nlr .I variabl€swe i.:irted the slacture of the rcgessior model usedby L.hnr..,r , !l hi in his original 1.r.. r .lrii analysisintroducespe^onal characteristicsahead.r ,r t,,, r' .irumstances and th. sL..jectivewell-being into a prediction €quationfor overa:l q, ll , ig We bave added r.r ri . : {,rel 10 allow us to explore tunher the contnbutionof :Jir,.. , r :ef ession.Overall Pnactp.l Compon.nG Faclor An.lys(

u(cc t=1279 In pati.nli Cs >2 y.d r=99

.72 .13 .65 ,a) .63 .61 2.9 42

.11 .16 .56 .65 .78 .51 3 42

t t5

ai.nr, d, r' ,nd shod \r.,. ( rJ..

QUA.IT

I'[INUK&CEPMANSAMPLES

lr rrn hicrl Reg.BsionAnolytis I L at

Gemn

D.mognphic& Objedir.

Denognphic,Obj.crivc&

Dcmognphic. Dcp6son,

well-being is rated on the fi.st .! ral quesiion:How do you f€el aboul vour life a! a who today? Th€ resultsare sho\li in rble 6. It is perhapsunderslandabl€, re. rhe degreeof varianceto be lbund in larg€ samplt tt that thiariount of varianceexp nci by theseregressionsis nol larg€ Having said tbat (1983) lnor and bv Lehnun onginallv seneral Dicrure is consiste.t r''r ihrt reponed iecentlv'bySchneider(personal, 'nmunicatron)in a sanple ofworking patients Beingoldr ru" well be'ng. but in ltus mod€l xge expldrnsvel is significrntll reEled Io lr pr' I l a d r L s r eR d ' v a l u eo f 0 0 2 i n L h ec o m b n e d r a m p ! 3 n a n ( e , r i r a c c o u litlle of lhe bv objectiaevariables'in Panrculr ! rriance is €xplained ! l"/, o{ ofabout orlv. An averaae wher depressionis introducr crime. ,rr a victim of .'f accus.. being friends-and haling th the av-eragcamount of vanancr ilpiiineil rises by nore than 2% ln the Berlin data modelid;dfiesdepressionastf.oleiaclorlikelvtob€associatedwilhove'allwcil-b€in: whereasin the UIiCC sampte .:ter objective factors are also found to have significal I effecls. When subjective eell .,ng donain ratings are itfoduced the total amount per cel almost foriy and to data in th€ Berlin .,il) !o 3tqo varjanceexplainedrises subsla.r ;n lhe UKCC data. ' An altemative approach is I' orlereC r€gressionmethod advocatedby Levii! et cnaracre g personal (1990). Using this apProach.var .bie53re assignedto prediclor setse islics, objective conditions and 'rii.ldve satisfactionwith life conditions and are enter€ l.r' Applving this model to our dala achieved.identic ;nto itre iegressio" atalysis in , results for ;bjective and subje. . I anabl€sas had been atlain€dusing Lebman s mode This suggesli that objecti\e \. rblcs exert nore influence on overal weil being lhr a"."gr"'p'r'tl" variablei an
co\{ I I SIoNS In

T h e h n d r n g \h e r e ' u P p o n $ e \ r e q

r ) a n ' m D o n d n Lb u l n o l d o m i n a n l

l',:")"lllil,Tl,1i:,L1T"ililJil'ji'J il*#ij:::'*1#i1J"li*':';::': b€Meen -iniistheindividDar rodisringuish 'r' r"' a"'""", ilfi;ii;;"."ss;i,ri;

:,,,i,i1$:t"i,"liix'#:q'il'J:ifl"": *hlkh:fu::*:l1,.::i?:

v,f*n}t.l;*Eir:,l*ru:*it,*"{in"".::i:i';: ::'tffi 'r l overa we -being The Geman dala shoq

3iJ!ii*:sJ'ff;T"]'*: .i .:i"lllili,ix [::fui:l,f;":*h.*i:*"ri;. ''i:i::"Tfi;;g"i;;1ffi:"TJl'* : ;-lx'Jt5lx "li:*;tx* "ii'ni"r*, *t" ufcC,".ults

werEretlio

' r' xosrexacrlv'

-ffi'5"#T:":"T"*lf*-*,,i,it:i.,*i:r*":ii",'r

10 the resul$ of the faclor analysls-

$'J:',"",j:r:111"Y",tTil,"t'!qli't;::*i*k;*.;1,: :' :'#ii.t',h11ii"s'Til.:.1i.: ;t';nu *j#t]i,ti'll',1 '.gi;"#J,x';i'"r.',T:i"",T'"'",?l'#,ii:]"''i made by ranngs of subjectrve\rell-bcrnl

*"*'"",'""H;+1"f

Ri fl rl \cEs A. (199r)M.6!n n8Hrdtth:A ttr' t | BO$iLING.

OP' ':tt4 aJUJtMcsunn'nt S'al'JMiltoDK'vDcs:

"ili*"i,"1ii1) ".il 3i}i, *{l$fl"il r':',*:,"i:"1?^"ift:,;l #':l'ff} ':3 ^{#t"olyA;,,; Y#'"1 l' ,i; l'1Y'H}"#";'""33*iffii o:AT;blll:: n,,i$,ss*snsthcnqudnvorM'A'chiv"orc'^"ol ,;9";1$;ffiff:'i'J;'r'i;.*-"'.. o I P,E1R m'nr,,rv Jr'i)oiL i' u chrcn'cJb *',+TTi'"1i1;i"? i-l sucosK\1\r\D.H i.ab Q!'!n orLr..nd M.na,H.ot'h ; ",''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''.tly;l:"Liff,lf:1i'i1H S.tr..i Poutl.de.:London q (' PIJEBE S, OLNTER,JPI & KAISER P.adn'ld lion.drcal PLIBL: WARNER.R. & HltloEY Pl tl99l\ PsJ 5 | .omorutv Bnusb& US Smphs ConJr

-:.1 Qkliry af Uf. and M.ntal Hedlth Cort \ nEhrson . rd Qulbry of Lr. Mois M'nr'llv lll Pati'trBin rhc r)Lnat oJ Psrchtotrr'163505-tU1

i(

SAMTLES QUA!]TYOFLII! IN UK & CERMAN

'', , - - . - _ - - - . - '- '"' n . * * " r . r ' " ' ' ^ a p " d H u \ r c " ' ! P r o l e s s o r o l P ' v ( h iB" 3 r Li '' r'rr*no Benaoouot' cm* variem'bcs ;;;;;"

"'''' 'l,?S:1fl "J?'i:iiff l;]"\i?"'r $*",1lli:fr:::::: ::;i:;L:'n':;#::fr it'"1 C,:1llrdence

to Sh.mll Evans